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Steroid side effects during lymphoma treatment | CION Cancer Clinics
Steroids in lymphoma chemotherapy, such as prednisolone in R-CHOP, are there because they act on the lymphoma cells themselves. On steroid days most people notice a big appetite, poor sleep, mood swings and higher blood sugar, then a tired dip when the tablets stop. Most effects come and go with each cycle. This page explains what to expect, who needs extra care, and which signs need same-day help. At CION Cancer Clinics, our haematology team plans myeloma and lymphoma care with you, discussed at a tumour board and explained in plain words.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- Why are steroids part of lymphoma chemotherapy?
- What effects are common on steroid days?
- How do steroid effects usually change across a cycle?
- What do families believe about steroids, and what is true?
- What changes for someone with diabetes?
- Who needs extra care, and what can this page not tell you?
- Common questions about steroids in lymphoma treatment
The short answer
Why are steroids part of lymphoma chemotherapy?
Steroids such as prednisolone and dexamethasone are part of many lymphoma regimens because they kill lymphoma cells directly. The effects people notice most are a big appetite, trouble sleeping, mood swings and higher blood sugar, mostly on the days you take them.
Not the same as bodybuilding steroids
These are corticosteroids, copies of a hormone your own body makes. They are not the anabolic steroids some people misuse to build muscle. In lymphoma they do three jobs at once: they act on the lymphoma cells, they reduce sickness from the other drugs, and they calm allergic reactions to drips.
Where you will see them in the plan
In R-CHOP, one of the most common lymphoma regimens, the letter P stands for prednisolone. It is usually taken as tablets for a few days at the start of each cycle. Other regimens use dexamethasone instead. Steroids are also often given just before a rituximab drip.
Why short courses matter
Most of the effects on this page come and go with the tablets. Short bursts, repeated each cycle, are very different from years of daily steroids. Many of the long-term effects people read about apply mainly to that longer use.
What people notice
What effects are common on steroid days?
Not everyone gets all of these. Tell your team about any that trouble you, because most can be eased.
Appetite and weight
Hunger can be intense, and some people gain weight across a course of treatment. Keep healthy snacks close and try not to fill up on sweets or fried food.
Sleep and mood
Steroids can make you wide awake at night, restless, irritable, very cheerful or tearful. Families often notice the change before the patient does.
What often helps
- Asking whether the tablets can be taken in the morning
- Warning the family that moods may swing
Blood sugar
Sugar levels rise, sometimes sharply. People with diabetes usually need closer checks, and some people without diabetes develop high sugar during treatment.
Stomach and body
Indigestion or heartburn, puffiness of the face, swollen ankles and higher blood pressure can all appear. Your team may give a stomach protecting tablet with the steroid.
Muscles and eyes
Some people notice weak thighs when climbing stairs or getting up from a chair, or blurred vision on steroid days. Both are worth mentioning at your next visit, sooner if they are getting worse.
Not sure whether this applies to you?
Ask an oncologistThrough one cycle
How do steroid effects usually change across a cycle?
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Treatment day
Many people feel surprisingly energetic, even after the drip. The steroid can mask tiredness, so it is easy to overdo things. Plan a quiet evening anyway.
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The steroid days
Appetite, restlessness and poor sleep are usually at their strongest. Blood sugar may be checked more often, especially if you have diabetes. Take the tablets exactly as written on your chart.
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The days after the tablets stop
Many people describe a dip: sudden tiredness, aches, low mood or feeling flat. Part of this is the steroid wearing off and part is the chemotherapy catching up. It usually lifts over the following days.
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Before the next cycle
Sugar and blood pressure usually settle back. Tell the team at your next visit what the last cycle was like, so the plan can be adjusted by them if needed.
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Signs that cannot wait
Black or tarry stools, vomiting blood, severe stomach pain, confusion, extreme thirst with passing large amounts of urine, or a fever with shivering need care the same day. Call 108 or go to the nearest emergency department and say the person is on chemotherapy with steroids. Steroids can hide a fever, so feeling unwell without one still counts.
Commonly believed
What do families believe about steroids, and what is true?
"Steroids are dangerous, so we will skip them and keep the chemo."
In many regimens the steroid is one of the drugs acting on the lymphoma. Leaving it out can weaken the treatment. Never stop, skip or change it on your own. Tell the team what worries you instead.
"Her anger and crying mean she is not coping with the diagnosis."
It may simply be the steroid. Mood changes on steroid days are common and usually pass when the tablets stop. If the change is severe, or includes confusion or strange thoughts, tell the team promptly.
"The weight gain means the lymphoma is growing."
Weight gain during treatment is usually from appetite and fluid held by the steroid. Lymphoma is judged by examination and scans, not by the bathroom scale.
"High sugar during treatment means diabetes for life."
Steroid-related high sugar often settles after treatment ends. Some people do need medicine for it during treatment, and a few go on to need longer care. Repeat tests after treatment tell you which.
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If you have diabetes
What changes for someone with diabetes?
What happens
What to do
Sugar readings climb on steroid days
Check more often if your team asks, and write the readings down
Your usual diabetes tablets may not be enough
Your doctors may add or adjust medicine; do not change it yourself
Readings fall once the tablets stop
Ask what to watch for, so a raised plan does not cause a low
Two teams are now involved
Make sure your diabetes doctor knows the steroid schedule
Being straight with you
Who needs extra care, and what can this page not tell you?
Steroids need more careful planning in people with diabetes, high blood pressure, stomach ulcers, heart failure, glaucoma, thin bones, or a past mental health illness. Tell your team about any of these before treatment starts, even if they seem unrelated to lymphoma.
Older people are more likely to feel confused or agitated on steroids, and to have trouble with sugar and blood pressure. A family member who sees them daily is often the first to notice.
Infections and steroids
Steroids lower your defences and can hide the usual signs of infection, including fever. White patches in the mouth, a sore throat or a burning feeling on passing urine are worth mentioning early. Some people are given a preventive medicine against certain infections while on treatment.
What this page cannot tell you
It cannot tell you which steroid is in your plan, how much, or for how many days. It cannot say whether a symptom is from the steroid, the other drugs or the lymphoma itself. Your chart and your haematology team hold those answers. Bring the chart and your sugar diary to every visit.
Carry a note in your wallet saying you take steroids as part of chemotherapy. Emergency doctors need to know.Questions we are asked
Common questions about steroids in lymphoma treatment
Why do I feel so low after the steroid tablets finish?
When the tablets stop, the energy boost they gave wears off and the tiredness from chemotherapy shows through. Many people feel flat, achy or tearful for a few days. It usually lifts before the next cycle. If low mood lasts or feels frightening, tell your team.
Can I take the steroid at night instead?
Ask your team before changing anything. Steroids are often suggested in the morning, with food, because taking them later can keep you awake. The timing written on your chart is what counts, and only the prescribing team should change it.
Will the steroids make my face puffy?
Some people notice a rounder face, especially after several cycles. It is caused by fluid and fat shifting under the skin. It usually fades gradually once treatment is over. It is a cosmetic change, not a sign of anything dangerous.
My father is diabetic. Is lymphoma treatment still possible?
Yes. Diabetes is common in people having lymphoma treatment, and steroids are still used. The team checks sugar more closely and may add medicine for the steroid days. Share his diabetes medicines and recent readings at the first visit, so planning starts early.
What can I eat to manage the hunger?
Choose filling foods that do not spike sugar: dal, eggs, curd, vegetables, roasted chana and fruit in moderation. Eat regular small meals rather than one large one. Limit sweets, fried snacks and sugary drinks. A dietitian can help if weight or sugar becomes hard to control.
Do steroids weaken the bones?
Long, continuous use can thin the bones. Short bursts with each cycle carry less risk, but it is not zero, especially in older women. Stay as active as you can, and ask whether calcium, vitamin D or a bone check is needed in your situation.
Can steroids cause stomach bleeding?
They can irritate the stomach, and the risk is higher with painkillers such as ibuprofen or aspirin. Your team may give a stomach protecting tablet. Black stools, vomiting blood or severe stomach pain need emergency care the same day.
Is it safe to stop the steroids suddenly?
Short bursts in a chemotherapy cycle are planned to stop on a set day. Longer courses sometimes need to be reduced slowly, because the body's own hormone takes time to recover. Either way, never stop or change them on your own. Follow the chart and ask the team.
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Sources
- Cancer Research UK — Steroids
- Cancer Research UK — R-CHOP
- Macmillan Cancer Support — Steroids
- NHS — Steroids
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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